Implant Cost Differences between Distal Radius Fixation Constructs (CPT 25607, 25608, and 25609)

Avi Goodman, MD1, Joseph P Johnson, MD1, Roman Hayda, MD1, Christopher J Got, MD2, Joseph A Gil, MD2 and Arnold Peter C Weiss, MD1

1Alpert Medical School of Brown University, Providence, RI, 2Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI

Background
Cost is an increasingly important consideration in hand surgery, including fixation of distal radius fractures. In order to deliver better value-based care, we must better understand implant costs. We hypothesized the extraarticular fracture patterns would have a lower implant charge than intraarticular fractures, and aimed to determine risk factors for increased cost.
Materials & Methods
Our institution�s billing databases were reviewed from 1/2016 through 6/2017 for patients undergoing outpatient distal radius fracture fixation, and stratified by CPT codes (25607 = extraarticular, 25608 = 2-piece intraarticular, 25609 = 3 or more piece intraarticular). Implant charge and components (including plates, screws, external fixators, and bone graft) were noted, as was gender, age, insurance status, and surgeon type (hand vs. trauma, and attending vs. fellow) Along with descriptive statistics, multivariable regression was used to determine implant cost drivers.
Results
147 patients underwent outpatient distal radius ORIF (CPT 25607: 44/29.9%; CPT 25608: 56/38.1%, CPT 25609: 47/32.0%). Implant charges were significantly lower for 25607 (,334) than either 25608 (,940) or 25609 (,862). The extraarticular fractures required significantly fewer distal screws/pegs (5.4) than either simple intraarticular fractures (6.3) or complex (6.2, both p=0.01). Significantly more 25609 cases required bone graft (25.5%) than either 25607 (9.1%) or 25608 (12.5%, both p<0.001).
Multivariable regression analysis revealed an increased implant charge associated with fracture pattern (25608 by , p=0.001, and 25609 by , p=0.03), while cases performed at the trauma center were associated with a lower charge, by (p=0.01). Bone graft use was associated with an increased charge of , although this was not significant (p=0.15). There was no charge difference associated with insurance status, age, gender, hand vs. trauma specialty, or fellow status.
Conclusions
Extraarticular fractures required fewer points of distal fixation, and were associated with lower implant charges than fixation of more complex fractures. Increased articular comminution (25609) required more bone graft. There was no difference in implant cost between Hand- and Trauma-subspecialty surgeons. There was a difference between charges at the two hospitals, although the implication is unknown. This data may be used to help construct pricing for distal radius fracture bundles and potential cost savings.

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